Autism spectrum and pretend play

Discussion in 'Special Education' started by waterfall, Mar 12, 2011.

  1. waterfall

    waterfall Virtuoso

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    Mar 12, 2011

    I have a student going through our RtI process right now that I could use a little help with. His teacher is VERY concerned as the classroom teachers with this student before her have been. The student was nonverbal until the age of 5. (He's now 9). He currently is on an IEP for speech/language and is now very verbal. He has a hard time working with other students and generall prefers to be alone in structured and unstructured situations. He often gets fixated on one thing and can't let it go. He is obsessed with legos. He also spends much of his class time tearing up tissues or breaking apart pencils. He doesn't respond to social cues well, but we're unsure if thats because he can't or just that he doesn't want to. So some things point to autism but others do not. For example, he doesn't mind schedule or routine changes (something I'd always learned was a big part of autism spectrum disorders). He also spends much of his time pretending to be a pirate or different animals. He'll say "I'm a lion!" and will literally be crawling around on the floor of the classroom roaring- something thats obviously pretty socially unacceptable at his age. Our school psych says that anyone on the autism spectrum will not be able to pretend play on any level as they are in fact very literal. I'd learned that as well- but are there ever exceptions? I'm getting a lot of pressure from my school to look into autism spectrum for this student- especially taking the nonverbal for 5 years thing into consideration. Part of me though thinks maybe he's just a "different" kid and he doesn't really have a disability perse. This student has been tested for emotional disability and adhd before and did not qualify for either. And with the pretend play thing, the psych is pretty much refusing to move forward on this- any advice?
     
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  3. mopar

    mopar Multitudinous

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    Mar 13, 2011

    Students on the autism spectrum are all very different. I have worked with a student diagnoses as high functioning autistic who was very imaginative with his writing, but only when it was about baseball and his favorite team.

    I also have work with a young lady who was diagnosed with Asperger Syndrome who likes to cut up paper to make costumes.

    So, I would say that there are exceptions. This disability is so diverse, I would never merely rule someone out because they didn't have some of the characteristics.

    Is there anyway that the classroom teacher can kind mention some of this to the parent and maybe recommend that the parent share this with the child's doctor....

    Our students diagnosed with autism always come from a pediatrician or other medical doctor, not our psych.
     
  4. bethechange

    bethechange Comrade

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    Demonstrating some pretend play is NOT a reason to not evaluate a student for ASD, especially if he is demonstrating many of the other quirks/behaviors you mentioned and there have been years of concerned staff members!

    If you know one person with autism, you know one person with autism. It affects every kid differently. I'd say in general, pretend play is impaired, but it can be impaired as in, not present or it can be impaired as in: happens at socially inappropriate times (check!), not flexible and reciprocal with peers, (check again!), or only happens when the topic is of your choosing and your interest (sounds like another check to me). You are right in being concerned. it is not normal for a 9-year old to crawl on the floor and pretend to be a lion during class.

    On the ADOS (instrument my school district uses to give educational identification of ASD), module 2 and 3, there are whole sections where items are provided to observe an individual's pretend play - whether or not they respond to your overtures, whether there is flexible reciprocal interaction, whether they can shift play schemas, etc. Kids can DEFNITELY have ASD and still demonstrate pretend play!

    ALSO - over the years, I have had some kids who do better than others with schedule changes. Just because they are not freaking out every time there is a change does not mean they don't have ASD! Also - I've beaten my head against the wall at times trying to get gen ed teachers to use schedules and visual supports - just because the kid is not falling apart does not mean he does not need them to be organized!

    I would DEFINITELY push to move on this. A lot of what you describe sounds very like high functioning ASD to me. What tools does your district use to give EI of ASD?
     
  5. monsieurteacher

    monsieurteacher Aficionado

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    Mar 13, 2011

    I second what bethechange says... I have a child with autism who LOVES to talk about robots and time machines... but it's an obsession about this. To put it bluntly, your school psych is wrong.
     
  6. WaterfallLady

    WaterfallLady Enthusiast

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    Mar 13, 2011

    I have a child with moderate autism that is the best pretend player I know! Any school psychologist that thinks in "always" and "never" terms might need some re-education.
     
  7. EdEd

    EdEd Aficionado

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    I'm going to take a slightly different angle on this. I don't have tons of experience with Autism, and by no means am an expert. Folks like bethechange and others seems to have some good experience, both with assessment and with intervention. My angle is going to be more related to the process of evaluation, including the role of RtI in this particular situation.

    First, if a child is suspected of having a disability that would impact a child's education, the LEA is required to conduct an evaluation of that child. If your school suspects that the child may have Autism, and that the child's demonstrated needs are impacting his access to FAPE, an evaluation must be conducted. Your school psychologist simply having a cursory conversation with you, or even doing a basic observation, does not relieve the LEA's burden to conduct an observation. The exception would be if the suspect disability could be unequivocally ruled out based on the presence of a particular variable. Like several have mentioned here, simply noting the existence of pretend play should not be enough to forego an evaluation under federal law, given the presence of multiple of other reasons to suspect the disability. Not only is this the case because a child with Autism could engage in pretend play, but because there has been no formal evaluation done to determine the exact nature of a child's play - part of the ADOS assessment is making very specific observations and ratings of a child's play and other behavior based on standardized prompts. Casual observation would not allow for a such a specific assessment, and in any case would not substitute for a formal evaluation

    Side note here: I don't want my comments to be taken that any time someone at a school has the slightest suspicion that a child may have a disability that an evaluation must absolutely be conducted - there needs to be reason to suspect. The key point in waterfall's example is that one small detail in the child's overall profile is being used to withhold an evaluation.

    Conclusion so far: When a disability is suspected based on multiple variables, the casual observation of one or two unconfirmed, possibly contradictory variables would not allow the LEA to withhold evaluation, and is specifically a violation of federal law.

    Alright, moving on to the RtI bit: Waterfall, your hands may be tied in this, but I've definitely noticed in multiple districts the misuse of RtI, which I've posted about before. With any new system, there are bound to be some misunderstandings and misapplications, but it's important to address those at the same time.

    From what I'm hearing, there may be a misuse of the RtI process going on here. First, RtI is generally not considered to be a means of providing additional support or a means of assessment for children with Autism. The only major applications of RtI at present are for "SLD," and in some locales ED/EBD (emotional disability). RtI has not been evaluated (to my knowledge), nor designed, to replace all models of evaluation for all children in need of special education services. True, all federal definitions of disabilities require that the child's needs are not related to a lack of instruction, but this does not translate into a need to go through a full 3-tier RtI process for children before receiving special education services. As a matter of fact, only the SLD language in IDEIA has been modified to open up room for RtI to be used, which is done so in a special section of the evaluation procedures called, "Additional Procedures for Identifying Children With Specific Learning Disabilities."

    Not only is RtI unwarranted, but it could be construed to be a violation of federal law, as the child is being denied an evaluation, and possibly subsequent special education services, in favor of using an alternative process of assessment and service-delivery which is neither (1) shown by research to be an effective response to children suspected of having Autism; nor (2) specifically authorized as an alternative means of evaluation by IDEIA for children suspected of a having Autism. If I were a parent and were advocating for this child, I might have strong legal ground to pursue action against the LEA if the LEA were to use RtI as a means of delaying an evaluation or service-delivery.

    Side note: This is NOT to mean that general education strategies should not be tried with kids who may or may not have Autism, or that less restrictive means of service delivery should not be pursued before moving to more restrictive means. It is also not to suggest that the inherent problem-solving structure of effective RtI processes would not be beneficial to children with Autism. However, in the context of protecting a child's access to FAPE who is suspected of having Autism, RtI likely does not satisfy the LEA's obligations, and more so is likely a violation of federal law.

    Overall, I think the specific behavior of pretend play should be further assessed and considered in the context of the entire evaluation, not used to withhold an evaluation. Furthermore, I would give significant consideration to the role of RtI in this process, and more broadly in your district. Not only might it be impeding service delivery, but it might well be a violation of federal law.

    And because I love side notes: I don't want my opinion here to be that this child should absolutely be evaluation, because I haven't seen the child. My points are intended more so as "general thoughts," which happen to likely be applicable in this situation. I'm always a bit hesitant when posting such technical responses!
     
  8. Proud2BATeacher

    Proud2BATeacher Phenom

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    Mar 13, 2011

    I have a student with autism who would be a dinosaur 24/7 if we let him. I also teach my class so that there will be changes in the schedule/routine, so that my students can learn how to deal with these changes in real life.
     
  9. waterfall

    waterfall Virtuoso

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    Mar 13, 2011

    That is interesting information- especially what you said abour RtI eded. I didn't realize it was only supposed to be used for SLD. That's really interesting because my district goes on and on about how "its the law" and they get VERY snippy about it. I've had the process dragged out for months and months for other kids because the district kept insisting we weren't doing the entire RtI process. One student ended up being identifed as SLIC (significant limited intellectual capacity- cognitvely delayed in other states). It was pretty obvious from the start that this would be the diagnosis- the student had been to preschool and kindergarten and only knew four letters. Is it possible that this varies from state to state? I've just noticed differences because my district literally only started doing RtI last year whereas in my old state RtI has been around for at least 5-6 years. I can't believe this district got away with not doing it for so long- so I figured the laws from state to state had to differ because in my old state the discrepancy based model has not been valid for quite some time now.

    We have a district "autism team" but we are only allowed to contact them for an evaluation if the student has been through the entire RtI process. Again, our exceptional student services directors will go on and on about this and are very rude if anyone questions it. They will not even consider the student otherwise- this is a district policy that unfortunately I don't really have any control over. They also will not allow us to do any "special evaluations" and we can only change or add disabilities to students' IEP's during thier Tri/reevaluation years. This student is due for a Tri this spring- so if we don't do it now we won't be allowed to look into it for 3 more years. The school has tried to talk to his mom about taking him for a medical evaluation before (in the years before I was at this school)- but she is not at all open to anything related to autism and doesn't want to take him to children's for an evaluation. I'm not sure they are legal immigrants- so that might be part of it. I assume this would be extremely expensive without insurance and applying for a sliding scale might require proof of citizenship (social security number). So our other option is to go through the district team to get an educational diagnosis, and to go through them we have to do RtI. The other problem besides the pretend play and not minding schedule changes is that this student is not really behind academically. He's on grade level for math and very close in reading. The only thing he's really behind in is writing. However, the majority of our students really struggle with writing because they're ELL's (word order, grammar, etc.), so that's pretty normal. Few students in every class are on grade level for writing. The speech pathologist argues that his biggest needs are still language related anyway- so no matter what the official diagnosis is he's already getting speech/language services. He wouldn't really need pull out time with me for academics since he's on grade level- and any classroom interventions that would help him are already being done. So really, putting him on an IEP for Autism wouldn't really change anything. He can even get testing accommodations through his speech/language IEP.
     
  10. EdEd

    EdEd Aficionado

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    Hey waterfall - I've found that, even beyond RtI, many district people would rather be safe than sorry on a lot of things, and end up "overcomplying" in a way that ends up hurting things!

    It varies on 3 levels:

    Federal: Makes no mention of RtI for any use other than SLD. Specifically prohibits states from prohibiting LEA's use of RtI, and prohibits states from required a severe discrepancy model.

    States: Creates state level laws, including state definitions about disability categories, etc.

    LEA: Specifically makes decisions about special ed checklists, discrepancy formulas, etc.

    Generally speaking, the feds set parameters which states can't contradict, but can set further definitions, parameters, etc. for LEAs to follow, who then set the most specific criteria and procedures.

    So yes - it definitely varies by state, and may well vary by district. The federal government isn't the one applying the pressure!

    Yep - states/LEAs make the decision. See my last comments below too.

    Unfortunate, and probably in violation of federal law. They are probably significantly exposing themselves to lawsuites, especially by vigilant parents who pay close attention to their rights. However, I'm certainly not an attorney, and have not had the burden of planning district level RtI implementation, so there may be something I'm missing.

    This is in specific violation of federal law, which I'll quote below. Notice the underlined section (which I underlined) which mandates that a reevaluation should occur if the district determines that a child's need warrant a reevaluation. If your district refuses to ever do a reevaluation, they are not considering a child's needs.

    § 300.303 Reevaluations. (a) General. A public agency must ensure that a reevaluation of each child with a disability is conducted in accordance with §§ 300.304 through
    300.311—
    (1) If the public agency determines that the educational or related services needs, including improved academic achievement and functional performance, of the child warrant a
    reevaluation
    ; or
    (2) If the child’s parent or teacher
    requests a reevaluation.
    (b) Limitation. A reevaluation conducted under paragraph (a) of this
    section—
    (1) May occur not more than once a year, unless the parent and the public agency agree otherwise; and
    (2) Must occur at least once every 3 years, unless the parent and the public agency agree that a reevaluation is unnecessary.


    Another thought in this area: Currently, the child only has speech services, so you're saying that if a child qualifies for speech in K, he is not able to receive any consideration for services - even under SLD/Autism/etc - for 3 years? If this is true, this is a gross, gross error that will almost undoubtedly open them up for legal action at some point.


    Sounds like you're being practical here. Unless you decide to take on the district's interpretation of federal policy in your first year as a teacher, which may not go over so well :). Sounds like you also won't make much progress with the parent(s) - whatever the reason, doesn't sound like they are going to get a outside eval, so you are doing what you can!

    Yeah, that's a fairly decent sized problem unfortunately that he's not behind (not unfortunate that he's doing well, but that that would prohibit you from services). You definitely need to show a documented need. Regardless of disability status, the child needs to be shown to have a disability, "and who, by reason thereof, needs special education and related services." Even if there are substantial behavioral issues, typically I've experienced that some sort of academic impact is required. And, even if writing is impacted, if the RtI cut scores are based on local norms (comparing this child's performance against others in the school, for example) there probably won't be a need identified. Personally, I think even behavioral difficulties should warrant additional services, but this is really a matter of how one defines "education." Do you know if your district would qualify a child based on behavioral needs that aren't presently impacting classroom performance? My guess from your other responses is probably no.

    Depending on the severity of the child's behavior, having him work with a Autism teacher could be very beneficial to his social development, and be a protective factor against future declines in academic performance. So, if you feel like there is a lot of problem behavior, you may want to go back and think about whether he would still be able to qualify with average achievement scores. I would be happy to brainstorm some assessment techniques you could use to show this "educational" discrepancy in the area of behavior, but if you district won't accept that type of discrepancy in an RtI model, it's probably not worth trying. Many don't.

    Another thought: just because the child's most specific disability determination might be Autism doesn't mean that has to be what he qualifies under. For example, let's say next year he is experiencing academic difficulty related to same-aged peers. If you can get past the 3-year rule, you might be able to do the RtI process and qualify him under an SLD label. Once he's through the "door" of special education, IEPs have to be based on a child's needs, not their identified disability, so you could secure services through that side door.

    ______

    One final thought about macro level change - it may be helpful for you to "make friends" with a person or two on the district level and gain their ear, even if for something totally unrelated. You definitely don't want to go over people's heads, or ruffle feathers, but if you happen to find yourself working with a district person and "happen" to slip in some concerns, you really might be able to do some good. You'd want to build a relationship with them first, of course, but if you're going to be there for a while there's a pretty big problem on your hands. It's probably unlikely that this would happen, but who knows.

    Also, another long shot for you to consider is calling some local minority rights advocacy, educational advocacy group, etc. - definitely anonymously or with a guarantee that your name wouldn't be used, but especially with disenfranchised groups that aren't used to advocating for their rights, there may be no counter-balance in the district to stand up for these kids' rights. In a district with wealthier, more active parents, I can almost guarantee some of these procedures wouldn't be in place, and if they were they'd be heavily contested.

    Not saying you want to cause more problems for yourself or the kids, and these last few ideas could simply be awful, but I'd sure be thinking of something I could do to change the system!
     
  11. bethechange

    bethechange Comrade

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    Mar 13, 2011

    The other problem besides the pretend play and not minding schedule changes is that this student is not really behind academically. He's on grade level for math and very close in reading. The only thing he's really behind in is writing. However, the majority of our students really struggle with writing because they're ELL's (word order, grammar, etc.), so that's pretty normal. Few students in every class are on grade level for writing. The speech pathologist argues that his biggest needs are still language related anyway- so no matter what the official diagnosis is he's already getting speech/language services. He wouldn't really need pull out time with me for academics since he's on grade level- and any classroom interventions that would help him are already being done. So really, putting him on an IEP for Autism wouldn't really change anything. He can even get testing accommodations through his speech/language IEP.

    Ahhhh! This baffles me. I have seen this happen so many times with kids with HFA/Asperger's (and I'm not saying this kid falls into that category for sure without knowing him, but it sounds likely to me). They're OK academically through early elementary school, so everyone assumes they are fine, when, in fact, they are falling further and further behind socially and emotionally, which can and very likely will have huge mental health and self-esteem implications later on. This kid is 9, so what...........in the 3rd grade? It's not gonna fly to break pencils and crawl on the floor like a lion for too much longer without his peers pegging him as the weird kid, maybe for good. Plus, if he has impaired perspective taking, I'd hazard a guess that as reading and writing get harder (less literal/concrete and more about character development, plot, sequence, etc.) that will get harder for him too.

    Kids with high functioning autism, in my humble opinion, need to be receiving direct instruction not just in the "rules" of social skills, but in metacognitive social thought - how to think about what others are thinking and why. Perspective taking, emotional regulation, executive function.....they don't learn this through observation and imitation like neurotypical kids, and it is often not hardwired into them. Sadly, this is not a very popular sentiment, as this is hard to teach and hard to measure.

    The statistics for people with Asperger's/HFA, even very bright people with college degrees holding a job and living on their own are abyssmal (like, around 3 percent) because they often don't have the skills to cope with the social and organizational demands of the workplace and independent living.

    Does the SLP at your school address pragmatic language? (Social goals that involve reading/responding to nonverbal social cues)?

    Sorry for the rant. I know resource teachers are totally swamped with huge caseloads and under pressure to work on academics. But I can't fathom how a district could say a kid being on an IEP for autism wouldn't change anything when SOMEBODY could be working on all these things that he's likely lagging in and are maybe even MORE critical to a his future than reading on grade level?

    Does your state/district have emotional/behavioral standards for elementary students?

    Good luck with handling the eval situation. I'd be interested to know how it shakes out.
     
  12. waterfall

    waterfall Virtuoso

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    Mar 13, 2011

    EdEd, I was just talking to one of my friends who is an OT in the district and she was telling me that we could get around the "special eval" thing by calling the meeting a Tri- which sounds like what you're touching on with the law thing. I do have another student that I've been sort of going back and forth with the district on- he had a Tri last year for speech/language but has some pretty serious reading deficits as well (long story about why academics weren't included in his reeval last year). I told my director I'd be happy to call this meeting a Tri. I haven't heard back yet. This situation may be a little different because we have to go through the district team to administer the ADOS, so I'd have to get thier approval anyway. I also have to go through an additional district team to prove that difficulties are not due to "cultural and linguistic diveristy." I understand why they do it, but its another huge hoop to jump through. I do have a student that is identified with an emotional disability that is not behind academically (there were some serious circumstances- the student has attempted suicide, etc.)- so they do allow it, but this student with the autism questions was already evaluated for emotional disability and did not qualify. Anything I've heard about autism in my district is that we have to prove that it effects their educational performance.

    Bethechange, I understand what you're saying when you say that reading may get more difficult for him in the future- but we can't really just identify him now on the basis that he will "probably" get further behind in the future. We don't have emotional/behavior standards in my state for students. The SLP does work on pragrmatic language, social language- basically everything he would need. She's very good. The student is capable of responding correctly to social cues, its just that he often does not. Again, we're not convinced this isn't just because he doesn't want to. He can also carry on a normal conversation if he chooses with back-and-forth dialogue- but he would prefer to play or work by himself.

    We are getting a counselor next year (our school is too small this year, but we are combining schools so we're big enough to have to have one next year) so I was planning on getting this student on his/her caseload. We do have a psychologist now, but unfortunately he is stretched so thin that he isn't even able to meet the service hours of students that are officially on his caseload to work on friendship groups, behavior things, etc. The counselor can pick up some of this slack next year- and a frienship group might be great for this student.

    EdEd, you might know this- or anyone else- in my old state if a parent requested an evaluation we HAD to do it. The kid could be the brightest kid in the class and if they requested an evaluation for SLD, cognitively delayed, etc. we had no choice. We could try to explain the RtI process and sort of "talk them out of it" if you will, but if they insisted we had to evaluate. Is this a federal law or again a state by state thing? Our psych actually asked our ess department this, and our director just said "RtI process is the law." You have to explain that this process is what we do. I'm wondering if this is a federal law- if it came down to it the parents could request an evaluation (not just for this student, we run into problems like this all the time). It's not the best way to go about it for sure, but if it would mean getting a student who needs services what they need, I'd do it rather than see the student suffer.
     
  13. EdEd

    EdEd Aficionado

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    Mar 13, 2011

    Hey waterfall - yes, they can - the law is pretty specific about this. I could see the district responding by saying that the RtI process IS a part of the eval, but this would be contradicted by the law when it says that an LEA has 60 days to complete the eval after the parent requests it. This is actually somewhat problematic for appropriate uses of RtI, as a side note. So, even if an LEA were to say RtI is part of the process, this section of the law could be envoked to speed up the process. I need to check later, though, because it's a reeval - I think the law says that an LEA doesnt have to do a reeval more than once a year even with parent request, but it sounds like it's been a year.
     
  14. EdEd

    EdEd Aficionado

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    Mar 13, 2011

    Alright, a brief follow-up. I checked, and I think my last comments were generally on target, but this is the section about the 60 day rule:

    (1)(i) Must be conducted within 60 days of receiving parental consent for the evaluation; or
    (ii) If the State establishes a timeframe within which the evaluation must be conducted, within that timeframe;


    Reading this more carefully seems to suggest that the state can establish an alternative timeline other than the 60 day rule if they chose, and that this alternative timeline can replace the 60 day rule. I guess I'd look at your state special education guidelines to what they say to be sure about the 60 day rule.
     
  15. bethechange

    bethechange Comrade

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    Mar 13, 2011

    waterfall - I'm glad your SLP will be able to target the social language piece with him and recognizes that it is important. I've been horribly frustrated in the past by people I've worked with's inability to recognize this area as a need and thus, write it into the IEP. I have a kid this year who also walks the can't/won't line with social cues - but I truly think his issue is impaired perspective taking. He can follow social cues, but if the situation doesn't interest him, doesn't see why he should (so people will think good thoughts about him, want to play with him the future, not think he's weird, etc.).

    Also - if he does qualify ASD and then in a year reading or writing starts to go south, it would be easy to get him into academic intervention - unless kids in your state can qualify for academic support with a primary disability of speech and language? Here we can't do that.
     
  16. bros

    bros Phenom

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    Mar 13, 2011

    Most states tend to stick with the federal 60 days, although some decide to do 45 days
     

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